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Dr. Jerry Umanus had seen a lot of violence in Afghanistan, spending more than a decade training doctors and tending to the poor in the war-torn country. But lately he was growing more worried about his safety.

As the glow of a successful presidential election fades, a picture is emerging of key post-election procedures taking place in secret and independent observers being kept in the dark while votes are counted and thrown out for irregularities.

KABUL — With more than 80 percent of the vote counted, the Afghan presidential election looks headed to a second round of voting, barring a last-minute deal.

The two frontrunners maintained their positions, with former foreign minister Abdullah Abdullah just shy of 44 percent and former finance minister Ashraf Ghani getting roughly 33 percent of the vote, according to numbers released on Thursday by the Independent Election Commission.

The election would mark the first democratic transition of power in Afghanistan’s history.

Tuesday was supposed to be the day the commission, the country’s main election body, released full preliminary results, but vote counters needed more time, said IEC director Ahmad Yousuf Nuristani. Full results are now set to be announced Saturday.

“To have accurate and transparent results, we needed to take two more days,” he said.

Despite Abdullah’s confident predictions he would win in the first round, Nuristani said it looks unlikely anyone will win a majority of votes, a result that would trigger an automatic run-off between the two top vote-getters. No other candidate is within 20 percentage points of Ghani. Abdullah, a fierce critic of Afghan President Hamid Karzai, came in second to Karzai in the controversial, fraud-tainted 2009 election.

The election commission’s announcement came on a day police officials say an Afghan policeman killed three Americans inside a hospital in the Afghan capital, one of a mounting number of attacks on civilian foreigners in Afghanistan.

A police official said the gunman opened fire about 10 a.m. inside a hospital run by the American aid group CURE, located on a busy road in western Kabul that is also home to the country’s parliament. The gunman killed three Americans as they entered the hospital and wounded an American woman, the official said. Two of the dead were father and son and the third was a CURE International doctor who had worked in Kabul for seven years, The Associated Press reported, citing Health Minister Soraya Dalil. A statement on CURE's website identified him as Jerry Umanos, a predatrician from Chicago. The wounded woman is a nurse, according to The AP.

The gunman was wounded and arrested, police officials said.

CURE is a religious-based medical nonprofit organization with headquarters in Pennsylvania that focuses on care for children in developing countries.

Foreigners have been increasingly targeted in Afghanistan recently, and this is the second such shooting this month by an Afghan policeman. On April 4, Associated Press photographer Anja Niedringhaus was killed and AP reporter Kathy Gannon wounded when a police commander opened fire on their car.

A Taliban spokesman could not immediately be reached for comment, but the insurgent group vowed to step up violence during the presidential election campaign. The vote was April 5, but vote-counting is continuing, and a second round of voting would kick off a new campaign season.

Before the election, there were also deadly attacks on a Kabul hotel and restaurant, both popular with foreigners, and a botched attack on a Christian day-care center for foreign children in which the attackers accidentally stormed the adjacent office of an American aid organization.

There’s been a growing sense of unease among the expatriate community in Kabul, and violence in the run-up to the election led many foreign aid organizations and election monitoring groups to pull their staffs from Afghanistan temporarily.

A statement from the Interior Ministry said police are still investigating the motive of the gunman.